Acetabular Reconstruction in Total Hip Arthroplasty

Abstract

The difficulties encountered in dealing with the bone deficient acetabulum are amongst the greatest challenges in hip surgery. Acetabular reconstruction in revision total hip arthroplasty can successfully be achieved with hemispherical components featuring a porous or roughened ingrowth surface and options for placement of multiple screws for minor acetabular defect. Acetabular component selection is mostly based on the amount of bone loss present. In the presence of combined cavitary and segmental defects without superior acetabular coverage, reconstructions with a structural acetabular allograft protected by a cage or a custom-made triflange cage have been one of preferred surgical options. The use of a cage or ring over structural allograft bone for massive uncontained defects in acetabular revision can restore host bone stock and facilitate subsequent rerevision surgery to a certain extent. But high complication rates have been reported including aseptic loosening, infection, dislocation and metal failure. On the other hand, recent literature is reporting satisfactory outcomes with the use of modular augments combined with a hemispherical shell for major acetabular defect. Highly porous metals have been introduced for clinical use in arthroplasty surgery over the last decade. Their higher porosity and surface friction are ideal for acetabular revision, optimizing biological fixation. The use of trabecular metal cups in acetabular revision has yielded excellent clinical results. This article summarizes author's experience regarding revision acetabular reconstruction options following failed hip surgery including arthroplasty.

Structural and Morselized Allografting Combined with a Cementless Cup for Acetabular Defects in Revision Total Hip Arthroplasty: A 4- to 14-Year Follow-Up

“…The main benefit of structural allografts was the capacity to restore bone stock, making any subsequent revision less complicated particularly in young patients. Nevertheless, the more the acetabular component was supported by the allograft, the greater the risk of failure noted was [ 36 ]. It has been reported that the potential of creeping substitution by the host bone was limited by a surface-to-volume ratio, with proportions of “internal repair” as little as 20% in massive allografts [ 13 , 37 ].…”

“…There is an increasing popularity in the use of modular porous metal augments to manage bone defect [ 36 , 40 ]. However, the durability of these implants remains to be validated [ 1 ].…”

Custom Triflange Acetabular Components in Revision Hip Replacement (Experience Review)

“…к другим вероятным причинам развития нес табильности cTac относят необходимость выполнения большого разреза во время хирургического доступа к ТБс для установки трехфланцевой конструкции и возможность повреждения нервов и сосудов при установке подвздошного фланца [6,23]. особенную опасность большой подвздошный фланец представляет из-за возможности повреждения верхнего ягодичного нерва с развитием недостаточности мышц в зоне его иннервации.…”

Techniques for the Management of Failed Surgery for Fractures of the Neck of Femur

“…Unless the metalwork has cut into the acetabulum and has produced a large defect, standard primary implants, both cemented and cementless can be used. Rarely, a large defect will have been incurred, necessitating the use of a revision shell [ 26 ]. Again care must be taken in impacting cementless shells into osteoporotic bone.…”